Drugs for Urinary Symptoms

[faceinthecrowd]

Hello all. After doing a lot of research, it's become clear that prostatitis encompasses a wide array of symptoms. The reason I post this is because although I sometimes have pain in the genital area, what has caused the major problem for me is my persistent urinary symptoms. My guess is that pain relief drugs wouldn't help with this. I have trouble starting my stream, it is often weak and thin, I have post-void dribbling, and I have the constant feeling as if my bladder is not entirely emptying out. All day, I feel like I have a hot sliver of something (I assume it's urine) lodged in my penis. I also have frequency. When I have a bowel movement, I start to leak out urine, something that never happened with me before. Also, whenever I take a shower, the heat immediately causes me to feel like I have to urinate, but when I reach the toilet, nothing comes out but a few little squirts. Anyone had symptoms like this? I had an IVP done, which showed that I was retaining a small amount of urine, but my doctor tells me it is such a small amount that it shouldn't really be noticeable. Catscan revealed nothing abnormal. So what's going on inside me? Is it maybe a nerve problem? And what drugs are best in dealing with urinary problems? No offense to those who suffer from the pain aspect of this disease, but I almost feel like I would trade the urinary symptoms for pain, and then just load up on painkillers.Flomax has been my savior - before I started on it, I literally could not void at all. But since then, 25 mg/day of Vioxx, 10 mg/day of Ditropan XL, and three capsules of Elmiron per day have done nothing more to help. I am also on Effexor, but that's for depression. Are there any drugs out there for urinary symptoms that I should know about, or perhaps up the dosage of the current drugs? PLEASE HELP. Thank you!

[Carlton Higgins]

I had the EXACT same urinary symptoms, and Flomax has helped me. Ask your doctor about it. After watching my diet and using the drug, I am pleased to say that I no longer have urgency, dribble, or pain, and frequency is down almost 60%.

What's happening to you is essentially urethral stricture, where the inflamed prostate pinches the urethra, causing urine retention and slight pain. Remember that prostate irritation comes and goes -sometimes it is more aggravated than at other times. I highly recommend Flomax, or another alpha-blocker.

[J Dimitrakov]

Hello all. After doing a lot of research, it's become clear that prostatitis encompasses a wide array of symptoms. The reason I post this is because although I sometimes have pain in the genital area, what has caused the major problem for me is my persistent urinary symptoms. My guess is that pain relief drugs wouldn't help with this. I have trouble starting my stream, it is often weak and thin, I have post-void dribbling, and I have the constant feeling as if my bladder is not entirely emptying out. All day, I feel like I have a hot sliver of something (I assume it's urine) lodged in my penis. I also have frequency. When I have a bowel movement, I start to leak out urine, something that never happened with me before. Also, whenever I take a shower, the heat immediately causes me to feel like I have to urinate, but when I reach the toilet, nothing comes out but a few little squirts. Anyone had symptoms like this? I had an IVP done, which showed that I was retaining a small amount of urine, but my doctor tells me it is such a small amount that it shouldn't really be noticeable. Catscan revealed nothing abnormal. So what's going on inside me? Is it maybe a nerve problem? And what drugs are best in dealing with urinary problems? No offense to those who suffer from the pain aspect of this disease, but I almost feel like I would trade the urinary symptoms for pain, and then just load up on painkillers.Flomax has been my savior - before I started on it, I literally could not void at all. But since then, 25 mg/day of Vioxx, 10 mg/day of Ditropan XL, and three capsules of Elmiron per day have done nothing more to help. I am also on Effexor, but that's for depression. Are there any drugs out there for urinary symptoms that I should know about, or perhaps up the dosage of the current drugs? PLEASE HELP. Thank you!

A simple PVR (post-void residual) can be quite revealing. IVP is of no use. My guess is that the Effexor is counteracting the effects of Flomax and making symptoms worse. Anyway, taking both is not a very good idea.

[Carlton Higgins]

I'm still on Effexor, and am virtually symptom free right now. A small percentage of people have reported increased urination and abnormal ejaculation due to the drug, but so far I've been o.k.

Nevertheless, I am keeping a close eye on the drug interactions. If symptoms come back strong, I will most likely ditch the Effexor.

The main reason for my Effexor intake is to help with Anxiety, which also causes people to urinate more. So its a kind of "damned if you do, damned if you don't" scenario.

[Hepcat]

Dr. D:

My pelvic ultrasound indicated a bladder volume of 474 cc and a post - void volume of 99 cc.

I've had some difficulty locating the normal range of volumes for a supine ultrasound of a full bladder (Which is funny since I practiced diagnostic imaging for many years), but I suspect mine is kind of low. As well, my residual appears to be around twice normal, yet the impression reports this volume as normal, along with the rest of the imaged parameters.

Could you offer an opinion on whether these volumes are indeed consistant with normal measures (or simply list what a normal measure for these parameters might be if you feel an opinion would be construed as medical advice).

Also, what kind of information would you find diagnostically useful in knowing the post-void volume (I can think of a few, but I'm curious what factors are of importance in your view).

Many thanks!

[JDevin1]

Elavil is by far the most effective drug I have taken for urinary symptoms. I started out at 10 mg per day, now I'm upto 75 mg. Saw palmetto and Flomax have also helped.

[Mike]

Elavil is by far the most effective drug I have taken for urinary symptoms. I started out at 10 mg per day, now I'm upto 75 mg. Saw palmetto and Flomax have also helped.

Interesting as for me who has no urinary symptoms that bother me anymore Elavil made it very difficult to pass urine it was like I couldn't feel the muscles down there or use them correctly. Made no difference to pain just made me sleepy all day every day I was on it. Stopped for those reasons. 75mg sounds a lot only 25mg did all this to me do you feel drowsy all the time?

Any side effect having built it up slowly?

[J Dimitrakov]

Could you offer an opinion on whether these volumes are indeed consistant with normal measures (or simply list what a normal measure for these parameters might be if you feel an opinion would be construed as medical advice).

Also, what kind of information would you find diagnostically useful in knowing the post-void volume (I can think of a few, but I'm curious what factors are of importance in your view).

Here's the info from Campbell's Urology, 2002 Edition:

page 1342-1343

Postvoid Residual Urine
PVR urine is the volume of fluid remaining in the bladder immediately after the completion of micturition. Studies indicate that residual urine normally ranges from 0.09 to 2.24 ml, with the mean being 0.53 ml ([46] Hinman and Cox, 1967). Seventy-eight percent of normal men have PVRs of less than 5 ml, and 100% have volumes of less than 12 ml ([40] DiMare et al, 1963). The AHCPR BPH Guideline Panel reached the following conclusions regarding PVR ([60] McConnell et al, 1994):

"¢ Residual urine volume measurement has significant intraindividual variability that limits its clinical usefulness.
"¢ Residual urine volume does not correlate well with other signs or symptoms of prostatism.
"¢ Large residual urine volumes may predict a slightly higher failure rate with a strategy of watchful waiting. However, the threshold volume defining a poorer outcome is uncertain.
"¢ It is uncertain whether residual urine volume predicts the outcome of surgical treatment.
"¢ It is uncertain whether residual urine volume indicates impending bladder or renal damage.
"¢ Residual urine volume can be measured with sufficient accuracy noninvasively by transabdominal ultrasonography. The measurement variation caused by the method is less than the biologic range of PVR variation.
The Fourth International Consultation initially recommended PVR determination in the initial assessment and during monitoring of patients under watchful waiting or other conservative treatment regimens ([39] Denis et al, 1998).

PVR measurement can be performed by noninvasive (ultrasound) and by invasive (catheterization) methods. The most common method is by ultrasound. Invasive techniques are accurate if performed correctly but carry a small risk of discomfort, urethral injury, urinary tract infection, and transient bacteremia (which has not been quantified in the literature). In addition to standard diagnostic ultrasound instruments for abdominal scanning, there is a much smaller, portable, and less expensive device to measure PVR (BladderScan; Diagnostic Ultrasound, Bothell, WA). Its reported accuracy is comparable with more expensive ultrasound units and catheterization. With this device, the mean difference between estimated PVR and "true" PVR (i.e., by catheterization) was 6.9 ml in 39 measurements taken in 20 children with neurogenic bladders ([58] Massagli et al, 1990). In 164 measurements in adult patients, the correlation coefficient was 0.79 ([49] Ireton et al, 1990).

The intraindividual variation in PVR measurement is significant, regardless of the techniques used. Although repeated measurements may minimize the error, this is either costly (noninvasive techniques) or uncomfortable (invasive techniques) for the patient. [31] Birch and coworkers (1988) reported that of 30 men with PBH, 66% had wide variations in PVR when three measurements were done on the same day. In 34% of patients, there was no difference among the three measurements. In 58%, at least two volumes were significantly different. In 8% of patients, all three were different. In most patients, two measurements were statistically similar whereas the third one yielded quite different results. [33] Bruskewitz and colleagues (1982) found similarly wide variations of the measured amount when they performed repetitive measurements of PVR (repeated two to five times) by in-and-out catheterization on 47 men before prostatectomy. They also found no correlation between the amount of residual urine and any cystoscopic or urodynamic findings, symptoms, or the presence or absence of a history of urinary tract infections.

Most clinical studies demonstrate minimal correlation between PVR and baseline measurements of symptoms, flow rate, or urodynamic measures of obstruction ([44] Griffiths and Castro, 1970; [23] Abrams and Griffiths, 1979; Shoukry et al, 1995).

However, [71] Neal and associates (1987) found a significant association in 253 men between PVR, age, "below normal" Qmax, and high urethral resistance. Low voiding pressure, however, did not correlate well with PVR. The authors concluded that outflow obstruction is related to the development of increasing amounts of PVR urine. In the AUA Outcome Study, [27] Barry and colleagues (1993) found a significant correlation between high PVR and low flow rates but no correlation with IPSS.

Traditionally, urologists have assumed that increasing amounts of PVR denote BPH progression and are thus an "indication" for surgery. This concept underlies the common inclusion of PVR in each individual government's appropriateness criteria. Unfortunately, data are lacking to support the predictive value of PVR. [25] Andersen (1982) studied 104 men with BPH and reported two patterns of BPH progression. The slow course was characterized by the development of high levels of PVR that resulted in decompensation of the detrusor muscle and eventually led to urinary retention. The fast course was associated with uninhibited detrusor contractions (UDCs). The amount of PVR, the presence of UDCs, and symptoms correlated poorly in the study. Nevertheless, Andersen recommended PVR as a safety parameter when measured longitudinally throughout the clinical course of a patient with prostatism.

[52] Jensen and coworkers (1988a, [53] b, [54] c, and [55] d) examined the prognostic value of PVR and 14 other clinical and urodynamic variables in relation to outcome of surgery in 120 men with prostatism. They found PVR the second best predictor of outcome, after pressure-flow studies. However, the combination of these two predictors did not allow the authors to correctly predict the outcome in any of 14 patients who failed treatment.

Data from the Veterans Affairs (VA) Cooperative Study Group randomized trial comparing TURP with watchful waiting demonstrated that PVR does not predict the outcome of surgery, and there was little evidence to support criteria that require a certain amount of PVR before surgery is justified. Additionally, high PVR did predict a slightly higher failure rate for watchful waiting. However, the majority of men with large residual urine volume did not require surgery during the 3-year duration of the trial.

In summary, PVR is best viewed as a "safety parameter." Men with significant PVRs should be monitored more closely if they elect nonsurgical therapy. However, the majority of men with elevated PVRs are apparently not at high risk for complications.

[Hepcat]

Since the micturation reflex can be triggered in normal individuals with volumes as low as 200 ml, it's no wonder those with high PVR's are rushing to empty nearly every hour (50-80 ml/hr; Tortora and Anagnostakos).

99 mls appears to fall in the grey zone of values for which no clear treatment plan is suggested (50 - 100+ mls). Although the reference you present suggests PVR is of questionable value for several conditions (including prostatitism) could it be argued that significantly higher but not clinically morbid volumes should have repeat measures taken at, perhaps, 6 mo intervals to monitor the state (as is suggested by the last line of the reference) of the urinary tract as a whole with an eye to preventing progressive conditions?

[faceinthecrowd]

Carlton, I'm wondering about one specific symptom. With Flomax, my urgency and frequency has decreased as well, but there is one symptom - this constant feeling as if I have something stuck or jammed in my penis - that has been extremely stubborn. I'm wondering if you have that specific symptom. It is a vague kind of feeling, and it's often hard to identify where exactly it's coming from. Do you have this symptom, and if so, what has helped with it? Thanks.

[webslave]

Your symptom could be caused by any sort of irritation or inflammation of the lower bladder, prostatic urethra or urethra.

[J Dimitrakov]

99 mls appears to fall in the grey zone of values for which no clear treatment plan is suggested (50 - 100+ mls). Although the reference you present suggests PVR is of questionable value for several conditions (including prostatitism) could it be argued that significantly higher but not clinically morbid volumes should have repeat measures taken at, perhaps, 6 mo intervals to monitor the state (as is suggested by the last line of the reference) of the urinary tract as a whole with an eye to preventing progressive conditions?

Remember the whole PVR concept was created for BPH patients. My personal opinion is it is not very useful in young men (younger than 35 years of age) and I do not base my judgement on that. Prostatitis-like symptoms in men mimic the overactive bladder more than anything else and as you know, quantitities as little as 5 mL, can trigger urgency in OA.

[JDevin1]

Elavil is by far the most effective drug I have taken for urinary symptoms. I started out at 10 mg per day, now I'm upto 75 mg. Saw palmetto and Flomax have also helped.

Interesting as for me who has no urinary symptoms that bother me anymore Elavil made it very difficult to pass urine it was like I couldn't feel the muscles down there or use them correctly. Made no difference to pain just made me sleepy all day every day I was on it. Stopped for those reasons. 75mg sounds a lot only 25mg did all this to me do you feel drowsy all the time?

Any side effect having built it up slowly?

Elavil made my frequency and urgency go down immediately, but I needed to take saw palmetto and Flomax to improve urine flow (which Elavil might have worsened).
I built up slowly and I only take it at night. I wake up feeling refreshed after a sound nights sleep for a change.

[faceinthecrowd]

What about drugs like Pyridium and the other urinary analgesics? Apparently there is an over-the-counter one called Uristat. Improvement of urine flow is not really my highest priority (although I'd appreciate any suggestions on how to do that). I'm more interested in combating the annoying sensation I have in my penis 24 hrs a day. This sensation is not exactly "painful," but is very irritating and frustrating. Would such drugs help this?